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WEDNESDAY, July 18, 2012 (MedPage
Today) — Women who have a lot of stress at work appear
to have a greater cardiovascular risk than those with lower-stress jobs, an
analysis of the Women's Health Study showed.

Both active jobs and those with a high level of strain were associated
with a 38 percent greater relative risk of having a cardiovascular event
through 10 years of follow-up, according to Michelle Albert, MD, MPH, of
Brigham and Women's Hospital in Boston, and colleagues.

High job strain, in particular, was associated with higher rates of
nonfatal MI and coronary revascularization, the researchers reported online in
PLoS One.

"With the increase of women in the workforce, these data
emphasize the importance of addressing job strain in cardiovascular disease
prevention efforts among working women," they wrote.

Previous studies exploring the relationship between workplace stress
and cardiovascular disease risk have yielded mixed results, although analyses
of predominantly male populations have generally supported a link between job
stress and incident cardiovascular events. The evidence has been less clear
among women, however.

So, Albert and colleagues examined data from 22,086 women (mean age
57) participating in the Women's Health Study, which randomized female health
professionals to vitamin E or aspirin for the primary prevention of cardiovascular
disease and cancer. Information on job-related stressors was collected in the
fifth year of the study.

The women were divided into four groups depending on their level of
reported job strain, which considers both demands and control in the workplace:

Passive jobs: low demand and low control

Active jobs: high demand and high control

Low-strain jobs: low demand and high control

High-strain jobs: high demand and low control

Through 10 years of follow-up in the current analysis, there were 170
MIs, 163 ischemic strokes, 440 coronary revascularizations (either CABG or
percutaneous coronary intervention), and 52 deaths due to cardiovascular
disease.

After adjustment for age, race, treatment arm, education, and income,
cardiovascular events were more likely among women with high job strain and
with active jobs compared with those with low-strain jobs.

Further adjustment for symptoms of depression or anxiety and for a
full range of traditional cardiovascular risk factors eliminated many of the
associations, although active jobs were still associated with a greater risk of
any cardiovascular event and high-strain jobs were associated with an elevated
risk of MI.

There was no relationship between job insecurity and long-term
cardiovascular risk, however.

Albert and colleagues said that job strain could contribute to
cardiovascular risk either through the behavioral responses to stress —
including smoking and depression — or through physiological processes
like stress-induced hypertension or metabolic syndrome.

In addition, chronic stress may result in dysregulation of the
hypothalamic-pituitary-adrenal axis and the autonomic nervous system, which
could have adverse biological effects.

The authors noted that more studies are needed on this issue and
acknowledged some limitations of their own analysis, including the relatively
homogenous study population (mostly white female health professionals), the measurement
of job strain and job insecurity at a single time point, and the potential for
residual confounding from unmeasured factors.

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